HIV and Life Expectancy: A Tricky Topic

One of the most common questions those working in HIV prevention and care get asked is how long do you live for if you’ve just been diagnosed as HIV positive. Although there are various stats out there, and a consensus that average life expectancy in richer countries of somewhere in the region of 20-30 years after diagnosis (or 13 years below average life expectancy for someone who is HIV negative see NHS info here ), this is an extremely difficult question to answer (also see article ). The main reason for this is because the transition from HIV to AIDS is dependent on many different factors. What are these and why do they influence life expectancy after being diagnosed as HIV positive?

Early or late diagnosis

One of the key elements of current HIV prevention work is to get people to test frequently and to know their status. One of the reasons for this is to ensure that if someone has seroconverted (gone from being HIV negative to being HIV positive) then they can receive treatment (if needed) as soon as possible. Also, about 25% of HIV positive men are not aware of their status and if they are not testing often these men are more likely to find out they are HIV positive because they have become ill. There is then an increased chance of life threatening complications even before any treatment can be started (more info here). For this reason a late diagnosis of HIV is closely related to a worse prognosis and a shorter life expectancy.

Strain of HIV

One fact that many people don’t know is that there are different strains of HIV. HIV-1 is the most common globally and HIV-2 is relatively common in Africa and relatively rare elsewhere. Within these strains there are various groups, which have varying prevalence rates geographically. For example, a group of HIV common in South America may be extremely rare in Japan, and so on. The link to life expectancy is that the progression from HIV to AIDS varies with each of these stands and groups and, what is more important, is that the mixing of different strains can form recombinant strains which can be more aggressive and difficult to treat. For example, a recombinant strain was recently discovered in Guinea Bissau which has been identified as the fastest ‘progressor’ of HIV-1, with time periods as short as 5 years between HIV infection and AIDS (see here ). This is especially an issue in parts of the world with large immigrant populations where various strains from different areas of the world are mixing frequently, such as London and New York. This is one of the reasons that positive prevention work encourages the use of condoms between partners who are HIV positive (there is also the risk of picking up other STIs which can cause the viral load to increase too). See a response to a question about unprotected sex between HIV positive men here ).

Life expectancy probability of someone diagnosed with HIV aged 25 in different eras

Taking meds

Quite simply medication only works If it is taken. This goes as much for HIV prevention as it does for any other indection. Antiretrovirals must be taken every day and ideally at the same time each day. This can be a challenge, especially for those who are recently diagnosed and not used to taking frequent medication. In addition, those that are HIV positive and on treatment for a long time can sometimes get ‘treatment fatigue’, especially when the viral load is undetectable and stable. Treatment adherence is a crucial factor influencing life expectancy. One only needs to look back to pre-‘95 when widespread treatment wasn’t available to see the effects of not taking effective antiretrovirals.

Treatment era

The graph above shows that as treatment has become more effective, life expectancy for HIV patients has increased. Whereas those in treatment between 1997-1999 and who were diagnosed at 25 had an average life expectancy of approximately 50 years (if they weren’t co-infected with Hepatitis C), this jumped to 67 years for those on treatment between 2000 and 2005 (see Danish cohort study) . Again, and to restate the argument above, whilst HIV treatment is more effective than ever before treatment is only effective when adhered too.

Our GMI healthrainers work across London providing sexual health advice and, on many of the shifts, providing HIV tests/working with clinics providing tests. To see the full list of locations and times for our healthrainer shift see the following link.